Mitochondria-Targeted Antioxidants for Treatment of  Age-Related Brain Disorders

ABSTRACT

A method for providing to a mammal a neuroprotective effect against a brain pathology that is associated with reactive oxygen species originating from mitochondria (mROS). The method includes the step of administering to the mammal an SkQ mitochondria-targeted antioxidant in an amount effective to provide said neuroprotective effect. The SkQ mitochondria-targeted antioxidant may be administered either prophylactically or for treatment with respect to brain pathologies other than brain trauma or stroke, and may be administered for treatment of brain trauma or stroke.

FIELD OF THE INVENTION

This disclosure is in the fields of pharmacology and medicine. Moreparticularly, this disclosure relates to the treatment ofneurodegenerative brain pathologies.

BACKGROUND

Age-related brain pathologies caused by neurodegeneration (ND), such asAlzheimer's disease (AD) and Parkinson's disease (PD), affect millionsworld-wide each year. Such brain pathologies are often mediated byreactive oxygen species primarily originating from mitochondria (mROS).However, although oxidative stress and mROS play a role in NDpathogenesis, this knowledge has not led to the development of aneffective treatment. For example, targeting a known antioxidant (MitoQ)specifically to quench mROS has failed (Murphy, et al., Ann. Rev.Pharmacol. Toxicol. 47:629-656 (2007); Snow, et al., Mov. Disord.25:1670-1674 (2010); Tauskela, Drugs 10:399-412 (2007); Lloret, et al.,J. Alzheimer's Disease, [Epub ahead of print, PMID: 21876249 (2011)).Moreover traditional antioxidants α-tocopherol, ascorbate and α-lipoate,although safe, have been ineffective in treating AD patients (Lott, etal., Amer. J. Med. Genet. 155:1939-1948 (2011)). This can be partiallyexplained by the fact that mROS normally perform several physiologicalfunctions of vital importance, and their total elimination entails deathof the organism. For example, mice and rats kept in a chamber withO₂-free air die within three weeks (Goldstein, Biochemistry (Mosc)67:161-170 (2002)).

Thus, there remains a great need for treatments for ND pathologies.

Previously, in US Patent Application Publication US 2011/0053895 (“the'895 application”), we described how mitochondria-targeted rechargeableantioxidants can be used for the prevention and treatment ofcardiovascular pathologies as well as diseases and pathologicalconditions originating from disorders of blood circulation or oxygensupply to tissues and organs. The '895 application includes examplesthat show that pretreatment with SkQR1 can provide a prophylactic effectagainst brain hemorrhagic stroke and behavioral abnormalities caused bycerebral compression ischemia. However, to date, there has been nothingthat would show or suggest a prophylactic effect ofmitochondria-targeted rechargeable antioxidants against other brainpathologies or an effect in the treatment of brain pathologiesgenerally.

SUMMARY

The inventors have discovered that mitochondria-targeted rechargeableantioxidants, including SkQ1 and SkQR1 and other compounds of formula(I) described in the '895 application as well as the functionaltruncated variant thereof described herein (herein collectively referredto as “SkQ mitochondria-targeted antioxidants”), can be used alone or incombination with glycolysis inhibitors to treat brain pathologiesdeveloping in elderly humans. Such brain pathologies include AD andother neurodegenerative diseases.

In accordance with this discovery, the invention comprises, in oneembodiment, a method for providing to a mammal a neuroprotective effectagainst a brain pathology that is mediated by reactive oxygen speciesoriginating from mitochondria (mROS), the method comprising the step ofadministering to the mammal an SkQ mitochondria-targeted antioxidant inan amount effective to provide said neuroprotective effect, wherein theSkQ mitochondria-targeted antioxidant is administered eitherprophylactically to inhibit the course of the pathology or for treatmentof the pathology after its onset with the exception that, where thepathology is brain trauma or stroke, the SkQ mitochondria-targetedantioxidant is administered only for treatment after onset of thepathology. In other words, the SkQ mitochondria-targeted antioxidant isnot administered prophylactically where the pathology is brain trauma orstroke.

In a preferred embodiment, the brain pathology is selected from thegroup consisting of brain ischemia, impairment of synaptic plasticity ina hippocampus of the subject, alcohol intoxication,hyperhomocysteinemia, and brain trauma. In another preferred embodiment,the SkQ mitochondria-targeted antioxidant is selected from the groupconsisting of SkQ1 and SkQR1.

In a further preferred embodiment, the SkQ mitochondria-targetedantioxidant is administered to the mammal in an amount of about 1 pmoleto 1 mmole per kg of body weight of the mammal per day, preferably 1mmole/kg/day to 100 mmoles/kg/day and more preferably 10 nmoles/kg/dayto 10 mmoles/kg/day.

In one embodiment, the SkQ mitochondria-targeted antioxidant may beadministered to the mammal prior to an appearance in the subject ofbehavioral defects due to the brain pathology. In another embodiment,the SkQ mitochondria-targeted antioxidant is administered to the mammalafter the mammal has contracted the brain pathology or after anappearance in the subject of behavioral defects due to the brainpathology. The SkQ mitochondria-targeted antioxidant may be administeredto the mammal by any mode of administration selected from the groupconsisting of intradermal, intramuscular, intraperitoneal, intravenous,subcutaneous, intranasal, epidural, oral, sublingual, intracerebral,intravaginal, transdermal, rectal, by inhalation and topical.

In yet another preferred embodiment, the SkQ mitochondria-targetedantioxidant is administered to the mammal in combination with aglycolysis inhibitor. Glycolysis inhibitors that are useful in theinvention include, for example, 2-deoxglucose and any other glycolysisinhibitor known in the art to inhibit, reduce, or stop glycolysis in acancer cell. In a preferred embodiment of the invention, the glycolysisinhibitor will be used in an amount of from about 0.05 μg/kg to about 5mg/kg of a patient's weight along with SkQ in an amount ranging fromabout 0.1 μg/kg to about 10 mg/kg of the patient's weight. Equivalentdosages can be administered over various time periods including, but notlimited to, about every 2 hours, about every 6 hours, about every 8hours, about every 12 hours, about every 24 hours, about every 36 hours,about every 48 hours, about every 72 hours, about every week, aboutevery two weeks, about every three weeks, about every month, and aboutevery two months. The number and frequency of dosages corresponding to acompleted course of therapy can be routinely determined according to thejudgment of a health-care practitioner.

In a still further embodiment of the invention there is described apharmaceutical composition for treating a brain pathology in a mammalcomprising a synergistically effective amount of SkQmitochondria-targeted antioxidant in combination with a glycolysisinhibitor.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing various features of the disclosure may be more fullyunderstood from the following description, when read together with theaccompanying drawings.

FIG. 1A is a graphic representation demonstrating that SkQR1 lowersbrain infarct volume measured by staining of brain sections with2,3,5-triphenyl tetrazolium chloride.

FIG. 1B is a graphic representation demonstrating that SkQR1 lowersdamage to the performance of the limb placement test in rats aftertransient middle cerebral artery occlusion.

FIG. 2A is a graphic representation demonstrating SkQ1 reversal ofage-dependent behavioral defects in Wistar rats as measured by theelevated plus maze (EPM), where the average number of entries into openarms of EPM is shown for young rats (3 months old, column marked with 3)and older rats (14 months old, columns marked with 14)—control (whitecolumn) and SkQ1 treated (black column).

FIG. 2B is a graphic representation demonstrating SkQ1 reversal ofage-dependent behavioral defects in Wistar rats as measured by theelevated plus maze (EPM), where the average time spent into open arms ofEPM is shown for young rats (3 months old, column marked with 3) andolder rats (14 months old, columns marked with 14)—control (whitecolumn) and SkQ1 treated (black column).

FIG. 2C is a graphic representation demonstrating SkQ1 reversal ofage-dependent behavioral defects in Wistar rats as measured by theelevated plus maze (EPM), where the average number of entries intoclosed arms of EPM is shown for young rats (3 months old, column markedwith 3) and older rats (14 months old, columns marked with 14)—control(white column) and SkQ1 treated (black column).

FIG. 2D shows average time spent into closed arms of EPM for young rats(3 months old, column marked with 3) and older rats (14 months old,columns marked with 14)—control (white column) and SkQ1 treated (blackcolumn).

FIG. 3A is a graphic representation showing long term potentiation (LTP)of hippocampal slice neurons characterized by time course of pop-spikeamplitude (%) in a control (non-treated) hippocampal slice.

FIG. 3B is a graphic representation showing the LTP caused by in vitroaddition of Aβ, where the decay of LTP of hippocampal slice neuronscharacterized by a decrease of pop-spike amplitude (%) in a hippocampalslice treated with Aβ.

FIG. 3C is a graphic representation demonstrating that SkQR1 treatmentin vivo prevents decay of the long-term potentiation (LTP) caused by invitro addition of Aβ to a hippocampal slice. SkQR1 Aβ was added 15 minbefore the LTP induction with high-frequency electric stimulation(arrow). The decay of LTP (i.e. decrease of pop-spike amplitude) in ahippocampal slice treated with Aβ can be prevented by SkQR1 treatment.

FIG. 3D is a graphic representation demonstrating that SkQ1 treatment invivo prevents decay of the long-term potentiation (LTP) caused by invitro addition of Aβ to a hippocampal slice. SkQR1 Aβ was added 15 minbefore the LTP induction with high-frequency electric stimulation(arrow). The decay of LTP (i.e. decrease of pop-spike amplitude) in ahippocampal slice treated with Aβ can be prevented by SkQR1 treatment.

FIG. 4 is a graphic representation of behavior parameters in the openfield test 4 hours after ethanol narcosis of a Negative Control group in% to intact control. (*−p<0.05);

FIG. 5 is a schematic representation of the behavior parameters in theopen field test 4 hours after ethanol narcosis of all groups in % tointact control. (*−p<0.05 for SKQ-1 250 nM compared to negativecontrol);

FIG. 6 is a graphic representation showing muscle strength measurement 4hours after ethanol narcosis in % to intact control. *−p<0.05 tonegative control, #−p<0.05 to intact control;

FIG. 7 is a graphic representation showing behavior parameters in theelevated plus maze test 24 hours after ethanol narcosis of NegativeControl group in % to intact control. (*−p<0.05);

FIG. 8 is a graphic representation showing behavior parameters in theelevated plus maze test 24 hours after ethanol narcosis in % to negativecontrol. (*−p<0.05 to intact control);

FIG. 9 is a graphic representation showing behavior parameters in theopen field test of chronically alcoholised rats in % to intact control.(*−p<0.05; **—p<0.005 to negative control; #—p<0.05, ##—p<0.01, tointact control);

FIG. 10 is a graphic representation showing behavior parameters in theelevated plus-maze test of chronically alcoholised rats in % to intactcontrol. (*−p<0.05; ** −p<0.005 to negative control; #—p<0.05,##—p<0.01, to intact control);

FIG. 11 is a graphic representation showing behavior parameters in thePorsolt forced swimming test of chronically alcoholised rats in % tointact control. (*−p<0.05 SKQ-1 to negative control); and

FIG. 12 is a graphic representation showing the consumption of 15%ethanol solution after deprivation in ml (*−p<0.01 on 1st day ofalcoholisation SKQ-1 to negative control; #—p<0,05 for average ethanolconsumption for 1-36 days SKQ-1 to negative control).

FIG. 13 is a graphic representation showing the inhibition of startlereaction to loud stimulus by pre-impulse in rats, where the histogrambars indicate the mean level of startle reaction after pre-stimulus as %to that of control group of rats (without hyperhomocisteinemia). l-mcorresponds to group of rats treated with high L-methionine diet, andskq+lm corresponds to group of rats treated with high L-methionine dietand SkQ1.

FIG. 14 is a graphic representation showing habituation of rats todouble acoustic stimulus in normal conditions, underhyperhomocisteinemia and under hyperhomocisteinemia treated with SkQ1,where motor reaction to the double stimulus and P values for differentpairs of groups is indicated.

FIG. 15 is a bar graph showing the nootropic activity of preferred SkQmitochondria-targeted antioxidants of the invention when administered toanimals in vivo.

FIG. 16 is a bar graph comparing the neuroprotective effects ofpreferred SkQ mitochondria-targeted antioxidants of the invention whenadministered in vivo in a model of Alzheimer disease.

DESCRIPTION

Throughout this application, various patents, patent applications, andpublications are referenced, either by including a citation to thepatents, applications or publications in the body of the specification,including the Background or by including a footnote that corresponds toa publication in the list of references provided on the last page of thespecification. The disclosures of these patents, patent applications,and publications in their entireties are hereby incorporated byreference into this application in order to more fully describe thestate of the art as known to those skilled therein as of the date of theinvention described and claimed herein. The instant disclosure willgovern in the instance that there is any inconsistency between thepatents, patent applications, and publications and this disclosure.

Prior to the detailed description of the invention which follows, oneshould understand that the invention is not limited to the particularmethodology, protocols, and reagents described here, as they are subjectto change. In addition, it should be understood that in the presentinvention, the terminology is used to describe particular embodimentsonly and does not limit the scope of the present invention which will belimited only by the appended claims. Unless otherwise specified, alltechnical and scientific terms used here have the same meanings that areunderstandable to those skilled in the art. With specific reference tothe term “brain pathology”, the same shall be considered to includebrain disorders and abnormalities, including but not limited to thosedescribed and exemplified herein.

1. Antioxidants

In the present disclosure, SkQ mitochondria-targeted antioxidants areused to treat age-related brain disorders. For example, plastoquinonyldecyltriphenyl-phosphonium (SkQ1) and plastoquinonyl decylrhodamine 19(SkQR1) have been used as described herein to study their effect onbrain function. The general formula of SkQ is described in the '895application and WO 2007046729. Other variants of SkQ, includingplastoquinone or methylplastoquinone, conjugated with lipophillicmoiety, are also useful for this purpose.

In the present disclosure, the following truncated SkQ variant(“C₁₂TPP”) is included in the SkQ mitochondria-targeted antioxidantsthat may also be used to provide the described neuro-protective effects.

2. In Vivo Studies—Effects on Ischemia

Several effects of SkQs were observed when brain functions were studied.Where indicated, 1 μmol SkQR1 per kg of body weight was injectedintraperitoneally 24 h before the 60 min occlusion of the artery. Theischemia effect was studied 24 h after the occlusion (Plotnikov, et al.,Biochemistry (Mosc) 75:145-150 (2010) here and below, p<0.05 for SkQeffect). In particular, a single intraperitoneal injection of SkQR1(0.5-2 μmol/kg body weight) to rats strongly decreased the infarctvolume in brain (FIG. 1A).

SkQR1 also decreased related behavioral defects caused by transientocclusion of the middle cerebral artery. Behavioral tests were performed1 day before the induction of ischemia and on the first day after theinduction of ischemia. The limb-placing test was used to evaluate theneurological deficit estimated by a conventional 14-point scale withmodifications as described in Jolkkonen, et al., Eur. J. Pharmacol.,400:211-219 (2000)). The test had 7 limb-placing tasks that assess thesensorimotor integration of forelimb and hindlimb responses to tactileand proprioceptive stimulation. The task was scored in a following way:the rat performed normally, 2 points; the rat performed with a delayexceeding 2 sec, and/or incompletely, 1 point; and the rat which did notperform normally, 0 points. FIG. 1B shows a decrease in these behavioraldefects after injection of SkQR1.

A demonstrative effect of in vivo treatment with SkQ1 was observed(Stefanova, et al., J. Alzheimer's Dis. 21:479-491 (2010)) whereage-dependant behavioral effects were studied in Wistar rats. Rats of 3months and 14 months old were investigated. An elevated plus maze withtwo open and two closed arms was used. Young animals placed in the mazecenter entered both types of arms with equal probability (FIGS. 2A and2C). However, the 14-month-old rats preferred to enter the closed armsonly (FIG. 2D), the probability of entering the open arms beingextremely low. If, nevertheless, a 14-month-old rat entered an open arm,the animal immediately left this arm (FIG. 2B). Addition of SkQ1 to thefood (250 nmol/kg body weight daily) for 10 weeks completely reversedthe age effect (FIG. 2D). With SkQ1, the probability of entering an openarm for the 14-month-old rats was as high as for young rats and, whenentering an open arm, the SkQ1-treated old rats spent in it a time whichwas almost as long as for the young rodents. Number of squares crossedby the animals in the open field test proved to be slightly smaller (by25%) for the 14-month-old rats than for the 3-month-old animals. Thisdifference was also abolished by SkQ1 (Stefanova, et al., J. Alzheimer'sDis. 21:479-491 (2010)).

3. In Vivo/In Vitro Studies—Effects on Synaptic Plasticity

One of the key events in the development of AD is the release of amyloidβ peptide (Aβ) from its protein precursor (APP) (Pagani, et al., Int. J.Alzheimer's Dis. 925050 (2011)). Impairment of synaptic plasticityoccurs before apoptotic and neurodegenerative events typical for theterminal stage of AD. It correlates with accumulation of Aβ, causing thesynaptic dysfunction and loss of memory accompanying AD (Selkoe, Science298:789-791 (2002); Oddo, et al., Neuron 39:409-421 (2003); Haass, etal., Nat. Rev. Mol. Cell Biol. 8:101-112 (2007)).

As a model of cell memory, an electric response of a hippocampal slice(long-term potentiation, LTP) was used (Malenka, et al., Science285:1870-1874 (1999)). A direct experiment was performed showing theprevention of Aβ toxicity in hippocampus by in vivo treatment of ratswith 1 μmol SkQR1 per kg of body weight. The compound was injectedintraperitoneally into the animal 24 hours before hippocampal sliceswere obtained to measure LTP. Some slices were pretreated with Aβ for 15minutes. As is seen in FIG. 3B, Aβ impaired LTP relative to untreatedcontrol. However, treatment of the animal with SkQR1 prevented suchimpairment (FIG. 3C).

These results show that mitochondria-targeted rechargeable antioxidantsof SkQ type are useful for the treatment of AD and other mROS-mediatedbrain pathologies.

Other experiments were done that show that SkQR1 demonstrates nootropicactivity when administered to animals in vivo (FIG. 15) and that alltypes of tested SkQs and C₁₂TPP demonstrate neuroprotective activitywhen administered in vivo in the model of Alzheimer disease (FIG. 16).Specifically, FIG. 15 shows the nootropic effect of SkQR1 using LTPsignal in neurons of hippocampal slices. As shown in FIG. 15, SkQR1clearly stimulates LTP indicating nootropic activity of SkQ.

FIG. 16 provides a comparison of the neuroprotective effects of SkQ1,SkQR1 and C₁₂TPP based on the LTP signal in neurons of hippocampalslices. Ab stands for beta-amyloid treatment. The experiment showedneuroprotective activity of SkQ1, SkQR1 and C₁₂TPP in the model ofAlzheimer disease. All SkQs and C₁₂TPP were administered in vivo to ratsprior the extraction of hippocampus. The results show that C₁₂TPPexhibits lower but still sufficient neuroprotective activity compared toSkQ.

4. Neuroprotective Effect of MTA Formulations on Alcoholism and AlcoholAbuse

In alcoholism treatment the procedures used can be divided into twosteps: detoxification during alcohol deprivation; and reduction ofalcohol motivation to prevent alcohol relapse.

In these experiments, 6 groups of experimental animals (Wistar rats)were used. (1) The Intact Control group (n=12), had no ethanol narcosis,and were orally administered a normal isotonic 0.9% NaCl solution; (2)the Negative Control group (n=12) was orally administered a normalphysiological solution after ethanol narcosis; (3) The SkQ1 50 nMcontrol group (n=12) was orally administered SkQ1 in a concentration 50nM after ethanol narcosis; (4) The SkQ1 250 nM control group (n=12) wasorally administered SkQ1 in a concentration of 250 nM after ethanolnarcosis; (5) The SkQ1 1250 nM control group (n=12) was orallyadministered SkQ1 in a concentration of 1250 nM after ethanol narcosis;(6) the SkQ1 1250 nM intr control group (n=13) was intraperitoneallyadministered SkQ1 in a concentration of 1250 nM after ethanol narcosis.

Four hours after awakening from ethanol narcosis, acute symptoms ofethanol intoxication were observed in an open field test. In theNegative Control group ethanol intoxication caused a decrease oflocomotor activity compared to Intact Control group: decreased tracklength (p<0.05), movement time (p<0.05), mean speed (p<0.05) andincreased immobilization time (p<0.05) (FIG. 4). The 250 nM SkQ1 dosehad the most pronounced effect, increasing track length (p<0.05),decreasing immobilization time (p<0.05) (FIG. 5). Ethanol intoxicationcaused muscle weakness (p<0.05) in the Negative Control group.Administration of SkQ1 250 nM reduced this effect, increasing musclestrength (p<0.05) (FIG. 6).

Twenty-four hours after ethanol narcosis, elevated plus maze (Treit etal. (1993) Pharmacol. Biochem. Behav. 44:463-9) and Porsolt forcedswimming (Petit-Demouliere et al. (2005) Psychopharmacol. (Berl). 177:245-55) tests were performed. In the elevated plus maze test, ethanolintoxication caused decrease of exploratory activity, resulting in lowernumber of rearing (p<0.05) and looking out from closed arms p<0.05) inthe Negative Control group compared to the Intact Control (FIG. 7). Inthe 250 nM SkQ1 group, the level of exploratory activity is higher:increased number of risk behavior (p<0.05), looking out from closed arms(p<0.05) (FIG. 8).

Thus, a single dose of mitochondrial antioxidant SkQ1 after ethanolnarcosis improved behavioral and physiological parameters, alleviatingacute alcohol intoxication. SkQ1 also had pronounced effect onchronically alcoholised rat.

Male albino rats had free access to a 15% ethanol solution, as well asto food and water. After 6 months of alcoholisation, animals withaverage consumption more than 11 ml of 15% ethanol solution were dividedinto two even groups and subjected to the following treatment. TheNegative Control group (n=16) (chronically alcoholised rats) were orallyadministered 1 ml per kg of isotonic 0.9% NaCl solution every two daysfor 20 days during alcohol deprivation. The SkQ1 group (n=17)(chronically alcoholised rats) were orally administered 1 ml per kg ofSkQ1 250 nM solution every two days for 20 days during alcoholdeprivation. The Intact Control group (n=10) (animals had no previouscontact with ethanol) were orally administered 1 ml per kg of normalphysiological solution every two days for 20 days.

After this course of drug administration, the effect on behavioralparameters was observed using the open field test, the elevated plusmaze test, and the Porsolt forced swimming test.

In the open field test, treated animals had increased number of rearing((p<0.05), number of entrance in central zone (p<0.01), movement time incentral zone (p<0.05)) compared to the Negative Control group (FIG. 9.Therefore, SkQ1 increases exploratory activity during alcoholdeprivation.

In the elevated plus maze test, the SkQ1 group had an increased tracklength in closed arms ((p<0.05), movement time in central zone (p<0.05),number of looking out from closed arms, rearing (p<0.005)) compared tothe Negative Control group (FIG. 10. This is indicative of lower anxietyin the SkQ1 group.

The forced swimming test showed a decrease of depression parameters;animals of the SkQ1 group had less immobilization time (p<0.05) (FIG.11).

According to behavioral tests, administration of SkQ1 during alcoholdeprivation can alleviate ethanol withdrawal symptoms: increasingexploratory activity, without hyperactivation of locomotor activity; anddecreasing anxiety and depression components in behavior.

After behavioral testing, ethanol consumption of 15% solution wasmeasured for 45 days. The level of ethanol consumption during first dayin the SkQ1 group was lower (p<0.01) than in the Negative Control group.The decreased ethanol consumption during first day indicates lower levelof ethanol craving after SkQ1 administration. During the next month, theaverage ethanol consumption was nearly 2× lower (p<0.05) in the SkQ1group than in the Negative Control group (FIG. 12). Additionally, thebody weight of rats after SkQ1 administration was higher (p<0.05).

Therefore, SkQ1 had pronounced effect on chronically alcoholised rat,decreasing ethanol consumption twice and improving behavior parametersduring alcohol deprivation without any correlation with individualbehavior parameters: increasing exploratory activity and decreasingdepression.

This data contains evidence that a mitochondrially targeted antioxidanthas neuroprotective activity in vivo. Such activity can be used forcreation of a treatment of alcohol abuse and alcoholism and otherconditions related to damage of nervous system, including withdrawalsyndrome.

The present disclosure utilizes mitochondrial antioxidants to treatalcohol intoxication and abuse. The disclosure provides a procedure totreat alcoholic patient with therapeutically-efficient doses ofmitochondrial-targeted antioxidant in order to decrease the damage doneby alcohol and it derivates and to reduce alcohol dependency of thepatient.

Administration of SkQ1 can be used in combination with basic alcoholtherapy. Exemplary modes of basic therapy used in a period of abstinenceinclude, but are not limited to, administration of sedatives,anticonvulsants, vitamins, electrolyte repletion, antidepressants, andpsychotherapy. Doses of all drugs are individual, as well as additionaltreatment, according to patient condition and co-occurring medicalproblems.

5. Neuroprotective Effect of MTA Formulations on Homocysteine-InducedBrain Damage

Hyperhomocysteinemia is associated with several neurodegenerativedisorders where glutamate receptors of modulators of glutamate receptorsare involved, such as Alzheimer's disease, schizophrenia. In adultshyperhomocysteinemia can cause cerebral aneurisms (Xu, et al. (2011)Neurosci. Lett., 494:139-44), pulmonary embolism (Karalezli, et al.(2011) Clin. Appl. Thromb. Hemost. Epub ahead of print), Crohn's disease(Maire, et al. (2001) Gastroenterol. Clin. Biol., 25: 745-8), nonalcoholic fatty liver disease (Bravo, et al. (2011) Lipids Health Dis.,10:60), dementia and Alzheimer's disease (Deshmukh, et al. (2010) Eur.J. Clin. Nutr., 64: 495-502], vascular dementia, cognitive impairment orsilent or asymptomatic embolic stroke, (Herrmann, et al. (2011) Clin.Chem. Lab. Med., 49: 435-41), brain atrophy in patients with brainepilepsy (Gorgone, et al. (2009) Epilepsia, Suppl. 1:33-6),atherosclerosis and thrombophilia (Kolling, et al. (2011) Cardiovasc.Toxicol. 11:67-73).

Hyperhomocysteinemia during pregnancy can cause preeclampsia,intrauterine growth retardation, premature rupture of the membranes,placental abruption (Murphy, et al. (2011) Adv. Clin. Chem., 53:105-37], early miscarriage (Vollset, et al. (2000) Am. J. Clin. Nutr.,71:962-8), gestosis (late toxicosis) (Azizi, et al. (2010) Bone,46:1344-8), neurocognitive impairment in children (Bhate, et al. (2008)Food Nutr. Bull., 29:249-54), microcephalia, megaloblastic anaemia, andhypotonia (Honzik, et al. (2010) J. Paediatr. Neurol., 14: 488-95),neural tube defects (Rogers (2008) Med. Hypotheses., 71: 406-10),hypotrophy (Molloy, et al. (2009) Pediatrics., 123: 917-23), and Down'ssyndrom (Murphy, et al. (2011) Adv. Clin. Chem., 53: 105-37).

An experiment was performed on 161 female Wistar rats (n=12) with bodyweight 200 g-250 g and their offspring (n=149) from 0 to 1.5 months old.All animals were SPF-category and were housed under the standardconditions according to GLP-regulations (controlled microbiologicalconditions, light-dark cycle 12/12 hours, ventilation rate 10-12 V/h,room temperature 22+2° C., with maximum change 1° C. per day, humidity30-70%). Rats were housed in individual cages with free access to foodand water.

Each female rat was held with 3 male rats for one night. First day ofthe pregnancy was considered to be the day when spermatozoon were foundin a vaginal smear. Hyperhomocysteinemia is experimentally developed byoral administration of L-methionine (Makhro, et al. (2008) Bull. Expt.Biol. Med., 146:37-39). L-methionine was added to the drinking water ofrats at the dose of 1 mg/kg of body weight per day for whole period ofpregnancy (approximately 21 d). L-methionine administration wascontinued after offspring birth (lactation period approximately 30 d).Therefore, offspring obtained L-methionine both with mother milk andfrom drinking water. Females of the experimental group were orallyadministered SkQ1 in dose 250 nM/kg in 50 ml solution once per 2 dduring period of lactation. Animals from the control group were givendistilled water instead of SkQ1.

On day 45 of life, pups were tested for schizophrenia symptoms inacoustical startle reflex. Normally (on control non-hyperhomocysteinemiarats) weaker pre-impulse (70 dB white noise, stimuli sound volume 80 dB,duration 20 ms) decreases reaction on louder stimulus (70 dB whitenoise, stimuli sound volume 100 dB, duration 20 ms) produced in 100 msafter first signal in comparison to louder stimulus given alone. Thisphenomenon is called pre-impulse inhibition. In the experiment stimuliwere produced 20 times with the background white noise (sound volume 70dB). In case of schizophrenia or similar disorders in brain functionspre-impulse inhibition and adaptation to the stimuli is less pronouncedor absent (Kar, et al. (2003) Exp. Toxicol. Pathol., 55(1): 69-83).

The results presented in FIGS. 13 and 14 demonstrate that offspring ofrats with hyperhomocisteinemia show deficit of pre-impulse inhibition(high mean level of startle reaction to loud stimulus given afterpre-impulse) that indicate development of schizophrenia. SkQ-1 given tomother rats normalized parameters of pre-impulse inhibition of theprogeny (FIG. 17). Rats after prenatal hyperhomocisteinemia show nonstable and very high reflex reaction on sound stimuli. In SkQ1-treatedgroup this effect of hyperhomocisteinemia was significantly reduced(FIG. 18).

6. In Vivo Studies—Effect on Trauma

In this study, we, the inventors, employed our modification of theearlier used model of focal open severe brain trauma in rats [13]. Thestudy was performed on male Wistar rats with body weight of 180-250 g.Before the surgery, the animals were anesthetized by an intraperitonealinjection of 3% chloral hydrate (330 mg/kg). To create the trauma, theleft frontal part of the skull was trepanized above the sensorimotorcortex zone, and a movable Teflon piston 4 mm in diameter with depth ofinsertion of 2.5 mm was placed into it; this piston was struck from theheight of 10 cm with a 50-g load sliding along a directing rail.Localization of the sensorimotor cortex zone was determined based ondata described in [14].

SkQR1 (100 nmol/kg) was injected intraperitoneally 1 h after the traumaand then daily in the same dose during the following four days.

A magnetic resonance imaging (MRI) study was performed as described in[15] using a BioSpec 70/30 (Bruker, Germany) with magnetic fieldinduction of 7 T and gradient of 105 mT/m. The damaged focal volume wasdetermined morphometrically on the 7th day after the trauma. For this,the brain of the animal was fixed by submerging it in a mixture offormalin ethanolacetic acid in the ratio 2:7:1 for 24 h; then the brainwas placed in 70% ethanol for 24 h; then serial sections were preparedusing a NVSLM1 vibratome (World Precision Instruments) with a step of100 μm. Every second section was sequentially mounted onto glassescovered with gelatin and stained with 0.2% Methylene Blue. Then thesections were treated routinely (dehydrated with increasing ethanolconcentration, cleared with xylene, and mounted in balsam) and scannedon a slide-device of an Epson Perfection V100 PHOTO scanner. As aresult, files were obtained with a picture of light-blue section of thebrain with a clearly shown damage area. The volume of the lesion wasdetermined as a cylinder with V=ΣSn×d, where d is thickness of thesection pair (200 μm); Sn is the area of the lesion in the section inmm2; Σ is the sum of volumes of ischemic damage in the sections using anImage J program (Bethesda Md., USA).

Behavioral “limb-placing test” was performed 24 h before the operationand then on the third and seventh days after the trauma. Neurologicdeficit caused by the skull-brain trauma was estimated using a 12-scorescale [16] in modification [17]. The resulting score on this scale isdetermined as the sum of points obtained in six tests assessing theresponse of the forelimbs and hindlimbs to tactile and proprioceptivestimulation in the presence of obvious reflexes. Malfunctioning of thelimb was estimated using the following system: 2 points corresponds tocomplete performance of the test; 1 point corresponds to performing thetest with a delay of 2 sec or incompletely; 0 point corresponded to thelack of response to the stimulation of the limb.

The results are expressed as the mean±standard error of mean. Theresults of behavioral tests were compared using the Mann-Whitney testfor independent samples. The statistical significance of differences inthe damaged volumes was assessed using Student's t-test at thesignificance level of p<0.05.

The animals were treated and subjected to experimental procedures inaccordance with requirements of the Counsel of the European Community86/609/EEC on use of animals for experimental studies.

Magnetic resonance images obtained on the first day after theskull-brain trauma allowed us to clearly identify the lesion area in thesensorimotor cortex of the left hemisphere. The localization of thedamaged area was in complete correlation with data on behavioralperformance based on the sensitivity and motor activity of the limbs.

The results of the limb-placing test revealed the development after thetrauma of a functional deficit in the right limbs, whereas it was absentin the left limbs. In the intact rats before the trauma, the test gave12 points for both the right and left limbs, and after the skull-braintrauma in the rats not treated with SkQR1 this score for the right limbswas 4.5±0.9 points on the third day (n=14) and 4.3±0.8 points on theseventh day (n=14).

The intraperitoneal injections of SkQR1 significantly decreased theneurological deficit. In this case the right limbs of the rats showed onthe third day 6.6±0.8 (n=14) and 7.4±0.8 points (n=14) on the seventhday after the trauma. The morphometric analysis after completing thebehavioral test revealed that on the seventh day after the trauma theinjection of SkQR1 decreased the damaged volume nearly twofold (to 15±4mm3 (n=14)), whereas without treatment with SkQR1 the damaged area was28±4 mm3 (n=13).

Thus, in our work the injection of SkQR1 to animals after skull-braintrauma was shown for the first time to significantly decrease theneurological post-traumatic deficit and the volume of lesion.

It has been earlier shown that extremely low, nanomolar concentrationsof mitochondria-targeted antioxidants, plastoquinone derivatives SkQ1and SkQR1, could be used on animal models of various pathologiesincluding Alzheimer's disease, cardiac arrhythmia, and myocardial andrenal infarction 2009, 2008, 2010, 2011 the pathogenesis of which issignificantly determined by increased production of ROS in mitochondria.On various models of ischemic brain stroke, we have demonstrated thatmitochondria-targeted antioxidants are efficient in preventing theconsequences of brain ischemia such as destruction of nervous tissue andneurological deficit 2008, 2010. Skull-brain trauma is another seriousmedical problem. In the present invention, this pathology was studied onour modified model of open focal brain trauma [13]. This model allowedto obtain a standard in the size and localization of cortical damageaccompanied by pronounced neurological deficit corresponding to clinicalmanifestations of the brain trauma. This model improves perspectives inthe search and experimental base for pharmacological correction of thiscerebral pathology.

The mechanisms of development of brain trauma and brain ischemia aresimilar in common, and the propagation of these pathologiessignificantly depends on mitochondria and the MMP [11, 18], which leadsto an increased production of ROS by mitochondria [10, 12]. These activemolecules directly damage lipids, proteins, and nucleic acids in thecell. ROS also activate different molecular signaling pathwaysassociated with cell death [19]. The increased production of ROS bymitochondria under conditions of both ischemia and trauma is the mostimportant pathogenetic detail in the mechanism of the neurodestruction.Therefore, it was reasonable to suggest that the trauma-induceddevelopment of neurological distortion could be decreased usingmitochondria-targeted antioxidants [20]. In the present invention, forthe first time we were able to demonstrate that the injection of SkQR1in nanomolar concentrations during four days after skull-brain traumareliably decreases the neurological deficit, whereas in the absence ofSkQR1 this deficit did not decrease during the same period. Themorphometric analysis of the damaged area revealed that in theSkQR1-treated rats the volume of the lesion in the brain cortex wassignificantly lower than in the untreated animals. The mechanism of theprotective effect can be mediated through the ability of SkQR1 todecrease the level of mitochondrial ROS and also to induce in vivoischemic tolerance due to initiating an increased production oferythropoietin that, in turn, decreases the activity of glycogensynthase kinase (GSK-313) [2011], which is involved in the apoptoticcascade in neurons under conditions of ischemia, trauma, and inAlzheimer's disease. Previously, there have been attempts to treatischemia and trauma using common, non-targeted antioxidants, but theirefficiency was rather limited, especially in clinical studies [22].

7. Therapeutic Administration

The route and/or mode of administration of the antioxidant-containingpharmaceutical compositions described herein can vary depending upon thedesired results. One with skill in the art, i.e., a physician, is awarethat routes or modes of administration, as well as regimens can beadjusted to provide the desired response, e.g., a therapeutic response.

Methods of administration include, but are not limited to, intradermal,intramuscular, intraperitoneal, intravenous, subcutaneous, intranasal,epidural, oral, sublingual, intracerebral, intravaginal, transdermal,rectal, by inhalation, or topical. The mode of administration is left tothe discretion of the practitioner.

For example, in some instances, the pharmaceutical composition describedherein is administered locally. This is achieved, for example, by localinfusion during surgery, by injection, by means of a catheter, by meansof a suppository or enema, or by means of an implant, the implant beingof a porous, non-porous, or gelatinous material, including membranes,such as sialastic membranes, or fibers. In some situations, thepharmaceutical composition described herein is introduced into thecentral nervous system, circulatory system or gastrointestinal tract byany suitable route, including intraventricular, intrathecal injection,paraspinal injection, epidural injection, enema, and by injectionadjacent to a peripheral nerve.

Pulmonary administration can also be employed, e.g., by use of aninhaler or nebulizer, and formulation with an aerosolizing agent, or viaperfusion in a fluorocarbon or synthetic pulmonary surfactant.

The pharmaceutical composition described herein can be formulated toinclude a suitable amount of a physiologically acceptable carrier orexcipient (see, e.g., Remington's Pharmaceutical Sciences, pp. 1447-1676(Alfonso R. Gennaro, ed., 19th ed. 1995)). Such physiologicallyacceptable excipients can be, e.g., liquids, such as water and oils,including those of petroleum, animal, vegetable, or synthetic origin,such as peanut oil, soybean oil, mineral oil, sesame oil and the like.The physiologically acceptable excipients can be saline, gum acacia,gelatin, starch paste, talc, keratin, colloidal silica, urea and thelike. In addition, auxiliary, stabilizing, thickening, lubricating, andcoloring agents can be used. In one situation, the physiologicallyacceptable excipients are sterile when administered to an animal. Thephysiologically acceptable excipient should be stable under theconditions of manufacture and storage and should be preserved againstthe contaminating action of microorganisms. Water is a particularlyuseful excipient when the pharmaceutical composition described herein isadministered intravenously. Saline solutions and aqueous dextrose andglycerol solutions can also be employed as liquid excipients,particularly for injectable solutions. Suitable physiologicallyacceptable excipients also include starch, glucose, lactose, sucrose,gelatin, malt, rice, flour, chalk, silica gel, sodium stearate, glycerolmonostearate, talc, sodium chloride, dried skim milk, glycerol,propylene, glycol, water, ethanol and the like. Other examples ofsuitable physiologically acceptable excipients are described inRemington's Pharmaceutical Sciences, pp. 1447-1676 (Alfonso R. Gennaro,ed., 19th ed. 1995). The pharmaceutical compositions, if desired, canalso contain minor amounts of wetting or emulsifying agents, or pHbuffering agents.

Liquid carriers can be used in preparing solutions, suspensions,emulsions, syrups, and elixirs. The pharmaceutical composition describedherein can be suspended in a pharmaceutically acceptable liquid carriersuch as water, an organic solvent, a mixture of both, orpharmaceutically acceptable oils or fat. The liquid carrier can containother suitable pharmaceutical additives including solubilizers,emulsifiers, buffers, preservatives, sweeteners, flavoring agents,suspending agents, thickening agents, colors, viscosity regulators,stabilizers, or osmo-regulators. Suitable examples of liquid carriersfor oral and parenteral administration include water (particularcontaining additives described herein, e.g., cellulose derivatives,including sodium carboxymethyl cellulose solution), alcohols (includingmonohydric alcohols and polyhydric alcohols, e.g., glycols) and theirderivatives, and oils (e.g., fractionated coconut oil and arachis oil).For parenteral administration the carrier can also be an oily ester suchas ethyl oleate and isopropyl myristate. The liquid carriers can be insterile liquid form for administration. The liquid carrier forpressurized compositions can be halogenated hydrocarbon or otherpharmaceutically acceptable propellant.

In other instances, the antioxidant-containing pharmaceuticalcomposition described herein is formulated for intravenousadministration. Compositions for intravenous administration can comprisea sterile isotonic aqueous buffer. The compositions can also include asolubilizing agent. Compositions for intravenous administration canoptionally include a local anesthetic such as lignocaine to lessen painat the site of the injection. The glycolytic enzyme or the glycolyticenzyme and the mitochondrially-targeted antioxidant can be suppliedeither separately or mixed together in unit dosage form, for example, asa concentrate in a hermetically sealed container such as an ampoule orsachette indicating the quantity of active agent. Where thepharmaceutical composition described herein is administered by infusion,it can be dispensed, for example, with an infusion bottle containingsterile pharmaceutical grade water or saline. Where the pharmaceuticalcomposition described herein is administered by injection, an ampoule ofsterile water for injection or saline can be provided so that the enzymeor enzyme and antioxidant and the carrier can be mixed prior toadministration.

The amount of antioxidant-containing pharmaceutical compositiondescribed herein that is effective for treating an ND can be determinedusing standard clinical techniques known to those with skill in the art.In addition, in vitro or in vivo assays can optionally be employed tohelp identify optimal dosage ranges. The precise dose to be employed canalso depend on the route of administration, the ND, the seriousness ofthe ND being treated, as well as various physical factors related to theindividual being treated, and can be decided according to the judgmentof a health-care practitioner. For example, an antioxidant or glycolysisinhibitor in an amount of from about 0.05 μg/kg to about 5 mg/kg of apatient's weight can be used. An antioxidant in an amount ranging fromabout 0.1 μg/kg to about 10 mg/kg of a patient's weight can be used.Equivalent dosages can be administered over various time periodsincluding, but not limited to, about every 2 hours, about every 6 hours,about every 8 hours, about every 12 hours, about every 24 hours, aboutevery 36 hours, about every 48 hours, about every 72 hours, about everyweek, about every two weeks, about every three weeks, about every month,and about every two months. The number and frequency of dosagescorresponding to a completed course of therapy can be determinedaccording to the judgment of a health-care practitioner.

In some instances, the pharmaceutical composition described herein is inunit dosage form, e.g., as a tablet, capsule, solution, suspension,emulsion, or granule. In such form, the pharmaceutical composition canbe sub-divided into unit doses containing appropriate quantities of thepharmaceutical composition described herein. The unit dosage form can bea packaged pharmaceutical composition, for example, vials, ampoules,pre-filled syringes or sachets containing liquids.

One exemplary pharmaceutical composition comprises SkQ1 and 3PO. Forexample, SKQ1 in amounts ranging from about 0.05 μg/kg to about 5000μg/kg of patient's weight and 3PO in amounts ranging from about 0.0001mg/kg to about 10 mg/kg of patient's weight are useful in thispharmaceutical composition.

Another useful treatment of ND is to administer an SkQ antioxidant incombination with a glycolysis inhibitor. Inhibition of glycolysisincreases mROS production due to increased activity of mitochondria. Oneway to inhibit glycolysis is to inhibit 6-phosphofructo-2-kinase (PFK-2)using any known PFK-2 inhibitor. For example, PFK-2 can be inhibitedwith 3-(3-pyridinyl)-1-(4-pyridinyl)-2-propen-1-one (3PO) (Clem, et al.,Mol. Cancer Ther. 7:110-20 (2008)). A combination ofmitochondrially-targeted

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1. A method for providing to a mammal a neuroprotective effect against abrain pathology that is mediated by reactive oxygen species originatingfrom mitochondria (mROS), the method comprising the step ofadministering to the mammal an SkQ mitochondria-targeted antioxidant inan amount effective to provide said neuroprotective effect, wherein theSkQ mitochondria-targeted antioxidant is administered eitherprophylactically to inhibit the course of the pathology or for treatmentof the pathology after its onset with the exception that, where thepathology is brain trauma or stroke, the SkQ mitochondria-targetedantioxidant is administered only for treatment after onset of thepathology.
 2. The method according to claim 1, wherein the brainpathology is selected from the group consisting of brain ischemia,impairment of synaptic plasticity in a hippocampus of the subject,alcohol intoxication, hyperhomocysteinemia, and brain trauma.
 3. Themethod according to claim 1, wherein the SkQ mitochondria-targetedantioxidant is selected from the group consisting of SkQ1 and SkQR1. 4.The method according to claim 1, wherein the SkQ mitochondria-targetedantioxidant is administered to the mammal in an amount of about 1 pmoleto 1 mmole per kg of body weight of the mammal per day.
 5. The methodaccording to claim 1, wherein the brain pathology is brain ischemia. 6.The method according to claim 1, wherein the brain pathology comprisesthe impairment of synaptic plasticity.
 7. The method according to claim1, wherein the brain pathology comprises alcohol intoxication.
 8. Themethod according to claim 7, wherein the SkQ mitochondria-targetedantioxidant is administered to the mammal after the mammal has undergonealcohol narcosis.
 9. The method according to claim 1, wherein the brainpathology is hyperhomocysteinemia.
 10. The method according to claim 9,wherein the mammal is a pregnant human.
 11. The method according toclaim 1, wherein the SkQ mitochondria-targeted antioxidant isadministered to the mammal prior to an appearance in the subject ofbehavioral defects due to the brain pathology.
 12. The method accordingto claim 1, wherein the SkQ mitochondria-targeted antioxidant isadministered to the mammal after the mammal has contracted the brainpathology or after an appearance in the subject of behavioral defectsdue to the brain pathology.
 13. The method according to claim 1, whereinthe brain pathology is brain trauma.
 14. The method according to claim13, wherein the SkQ mitochondria-targeted antioxidant is administered tothe mammal daily after the mammal has experienced the brain trauma for aperiod of at least 4 days after the trauma.
 15. The method according toclaim 1, wherein the SkQ mitochondria-targeted antioxidant isadministered to the mammal by a mode of administration selected from thegroup consisting of intradermal, intramuscular, intraperitoneal,intravenous, subcutaneous, intranasal, epidural, oral, sublingual,intracerebral, intravaginal, transdermal, rectal, by inhalation andtopical.
 16. The method according to claim 1, wherein the SkQmitochondria-targeted antioxidant is administered to the mammal incombination with a glycolysis inhibitor.
 17. A method for providing to amammal a neuroprotective effect against a brain pathology, the methodcomprising the step of administering to the mammal an SkQmitochondria-targeted antioxidant in an amount effect to initiate anincreased production of erythropoietin in the mammal.
 18. The methodaccording to claim 17, wherein the brain pathology is selected from thegroup consisting of ischemia, trauma and Alzheimer's disease.
 19. Amethod for providing to a mammal a neuroprotective effect against abrain pathology, the method comprising the step of administering to themammal an SkQ mitochondria-targeted antioxidant in an amount effect tocause a decrease in the activity of glycogen synthase kinase (GSK-3β) inthe mammal.
 20. The method according to claim 19, wherein the brainpathology is selected from the group consisting of ischemia, trauma andAlzheimer's disease. 21-27. (canceled)